The New No-Knife Necklifts To Know

Neck issues affect everyone eventually. "I spent so much time standing in front of the mirror, pulling up the skin of my neck," says Susan Nathan, 63. "I was too afraid to go under the knife, but I hated the sagging." Luckily, new treatments can take 10 to 15 years off your neck and delay, if not totally replace, surgical lifts. "The new noninvasive and minimally invasive options have revolutionized the approach to the neck," says dermatologist Robert Anolik of New York's Laser & Skin Surgery Center. "We now use injectables to lift, ultrasound and radio frequency to boost collagen, and lasers to improve the appearance of the skin." Sagging in the neck is caused by a breakdown of collagen and elastin due to aging, genetics, smoking, and environmental factors such as sun exposure. The best lifting and smoothing results come from a tailored, layered approach. Nathan went to New York dermatologist Neil Sadick, who used the filler Restylane to fill and lift her jawline, and Ultherapy, an ultrasound treatment, to tighten the skin. "The change is amazing," she says.

Every top doctor agrees: The first line of attack is the jaw, where loss of bone and muscle from aging causes the neck skin below to sag. Hollywood's go-to dermatologist, Harold Lancer, often injects a filler like Voluma at the spot where the earlobe meets the jaw. "It's like a push-up bra, pulling skin up," he says. And the results are instant. While there may be bruising, fillers involve minimal downtime and last up to 14 months. (Cost: $600–$1,500.) To soften prominent neck bands, Anolik also injects Botox along the vertical muscles of the neck to create a smoother look. (Cost: $400–$800.) Results last for three to four months. Once the structure that holds up the neck has been strengthened, Ultherapy and radio frequency treatments can firm and tighten the skin. Ultherapy's ultrasound waves go deep beneath the surface, stimulating new collagen. It takes about three months to see results, and results last a year or two. There is minimal downtime, but the pain factor can be, well, not so minimum. Some patients are given a hospital-grade painkiller before the treatment. (Cost: $1,400–$4,500.)

Clever combo treatments are the specialty of Paul Jarrod Frank, a New York dermatologist who pairs Ultherapy with radio frequency treatments, including the new Exilis Elite. "Ultherapy is too painful to use over the Adam's apple," he says. "Exilis uses radio frequency to heat the skin and boost collagen on a more superficial level. For mild to moderate skin laxity, I use it alone." Frank claims that Exilis feels like a hot stone massage. It takes about an hour but may require up to five treatments. (Cost: $1,500–$5,000 for a series.) The dreaded double chin, or submental fat—usually caused by genetics, not avoirdupois—can now be treated with Kybella. "The injectable solution [deoxycholic acid] acts by dissolving fat cells," explains Sadick. After a topical anesthetic is applied, approximately 20 tiny injections are aimed at the fat pads. Expect a mild burning sensation. Two treatments spaced a month apart are recommended; those with more fat may need three to six. Side effects can include swelling, numbness, and bruising for up to two weeks. Results, which are permanent, are seen in 30 to 90 days. (Cost: $1,500–$3,000.)

Kybella is for small areas. CoolSculpting can treat wider neck areas. The pain-free technique uses a handheld device to chill skin, literally freezing fat cells to death while leaving innocent cells untouched. "There may be some numbness and tingling for a few weeks," says Anolik. Two or three follow-up treatments a month apart will maximize results, which are permanent. (Cost: $600–$1,200.) On the thin line between noninvasive treatments and surgery is the Silhouette Instalift. Using a needle, a doctor puts two to six tiny sutures beneath the skin from the top of each ear to the jawline. The sutures, which eventually dissolve, act like strings, pulling up the skin. "It's like a suspension bridge," Lancer says. Results last for up to three years. (Cost: $2,000–$5,000.) For the bridge-wary (and younger) among us, judicious prejuvenation is key. "The most important step is sunscreen," Anolik says. And prescription Retin-A will delay crepiness. But for serious prevention, consider Ultherapy. "If you start in your mid-30s," he adds, "it can prevent the skin from sagging."

This article originally appeared in the March 2016 issue of Harper's BAZAAR.

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